Heart Health

Cutting-Edge Therapies for Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is the most common monogenetic cardiovascular disorder occurring in about 1 per 500 people in the general population. Approaches to the treatment of HCM vary considerably depending on how the patient is affected. At Emory Healthcare, we are fortunate to have true experts capable of providing state-of-art therapies which range from genetic counseling or simple life-style adjustments to cardiac transplantation. Patients at risk for sudden cardiac death receive life-saving cardiac defibrillators. Those with drug-refractory symptoms due to obstruction of outflow from the heart receive septal reduction either by open heart surgery or by catheter ablation. The Emory Hypertrophic Cardiomyopathy Center is a regional and national center of excellence capable of addressing the full range of challenges in the patient with HCM.

For more information about programs that make up the Emory Heart & Vascular Center, visit emoryhealthcare.org/heart.

About John Douglas, MD

John Douglas, MDDr. John Douglas is an interventional cardiologist at the Emory Heart & Vascular Center. He is also a Professor of Medicine at Emory University School of Medicine and Director of the Interventional Cardiology Fellowship Program. He is one of the most tenured Emory cardiologists, beginning his career in 1974. He has been recognized in America’s Top Doctors, Atlanta’s Top Doctors and The Best Doctors in America.

Advancing Patient-Centered Cardiac Care

Patient Centered Cardiac CareOne of the chief goals of quality healthcare, as defined by the Institute of Medicine, is to provide patient-centered care. Doing so requires “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine, 2001). As patients know, this kind of care doesn’t always happen. Providing patient-centered care requires effective communication and a trusting relationship. It also requires high-quality evidence regarding what forms of treatment are most likely to advance patients’ goals.

Emory has placed patient and family centered care at the top of the list of priorities and is taking important steps to make this happen. The Patient and Family Advisor program, for example, has created a way for patients and families to be “at the table” in important discussions about the way that care is delivered within our system. The clinicians at the Emory Heart & Vascular Center are active participants in helping to transform care at Emory and are committed to working with our patients to provide them with care that is most consistent with their goals. My colleague Dr. Cassimatis, for example, recently wrote on this blog a very helpful set of tips that will help patients to get the most out of their visit and ensure that their questions are answered. Emory cardiologists are committed to answering these questions and to working with patients and their family members to make decisions that are often complex.

Emory cardiologists are also actively conducting research to advance the mission of patient-centered care. Emory physicians are studying how our patients want us to communicate with them about research studies for which they might be eligible. Emory physicians are studying what information is most important to patients undergoing evaluation and treatment for severe heart failure. And Emory physicians are studying the role of new tools for communicating with patients about the risks and benefits of cardiac procedures. These are just a few examples of the ways that Emory physicians and researchers are helping to improve communication and facilitate the kind of trusting relationship that is essential to effective patient-centered care.

Because no decision can adequately reflect patients’ values without evidences, Emory doctors are also at the forefront of conducting clinical research studies that are essential to address many of the pressing problems that patients face. It is only through well-done research that we will have the information our current and future patients need to make decisions that are consistent with their goals.

In all of these ways, the clinicians at the Emory Heart & Vascular Center are committed to ensuring, and to helping other doctors ensure, that patients’ decisions match their values as much as possible.

If you have feedback or suggestions on how to improve patient-centered care at Emory Healthcare, please let us know by leaving a comment below. To make an appointment with an Emory cardiologist or cardiovascular specialist, please call 404-778-7777.

About Dr. Dickert

Neal Dickert, MD, PhDNeal Dickert, MD, PhD is Assistant Professor of Medicine in the Division of Cardiology. He also holds a secondary appointment in the Department of Epidemiology at the Rollins School of Public Health and is a senior faculty fellow at the Emory Center for Ethics. He also serves as associate program director for the cardiology fellowship program. Dr. Dickert received his MD from the Johns Hopkins University School of Medicine and PhD from the Johns Hopkins Bloomberg School of Public Health. Dr. Dickert is board-certified in cardiology and internal medicine. Clinically, Dr. Dickert practices in the Emory University Hospital and Atlanta VA Medical Center Cardiac Care Units. Dr. Dickert’s research focuses on ethical issues relevant to cardiology practice and clinical research.

Irregular Heartbeat: Is it Normal? – Join Us for a Live Web Chat!

Arrhythmia live chatHave you ever felt like your heart skipped a beat? Do you experience palpitations or “fluttering?” This is a symptom of a very common rhythm disorder called an arrhythmia. Arrhythmias are common in young- and middle-aged adults. Some arrhythmias are relatively harmless, but others can be fatal if not treated. Nearly 1,000,000 people are hospitalized for an arrhythmia each year, and some arrhythmias, such as Atrial Fibrillation, are extremely common and affect over 2,500,000 million Americans.

Other symptoms of arrhythmia include:

  • Fatigue
  • Dizziness
  • Lightheadedness
  • Fainting (syncope) or near-fainting spells
  • Rapid heartbeat or pounding
  • Shortness of breath
  • Chest pain
  • In extreme cases, collapse and sudden cardiac arrest

Join me on Tuesday, February 24, at 12:00 p.m. for a live, interactive web chat on the topic of “Living With and Treating Arrhythmias.” Dr. Michael Hoskins will be available to answer questions and discuss various topics about arrhythmias, including symptoms, diagnosis, prevention and treatment.

During this interactive web chat, you’ll be able to ask questions and get real-time answers from our Emory Healthcare professional.

Register now for our February 24 chat at emoryhealthcare.org/mdchats.

About Dr. Hoskins

Michael Hoskins, MDMichael Hoskins, MD , is an assistant professor of medicine and electrophysiologist who practices primarily at Emory University Hospital. Dr. Hoskins received his medical degree from the Medical College of Wisconsin in Milwaukee, after which he completed his residency in internal medicine at Emory. He was chief resident in Internal Medicine from 2005 to 2006. He then completed fellowships in cardiology and electrophysiology, also at Emory, and has been practicing here since 2010. He specializes in treating cardiac arrhythmias, focusing on ablation of arrhythmias and implantation and management of pacemakers and defibrillators.

About Emory’s Arrhythmia Center

Emory’s Arrhythmia Center is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our electrophysiologists have been pioneers in shaping treatment options for patients with arrhythmias such as atrial fibrillation, as well as for those with congestive heart disease. Our specialized electrophysiology (EP) labs host state-of-the-art equipment, including computerized three-dimensional mapping systems to assist with the ablation of complex arrhythmias, and an excimer laser system to perform pacemaker and defibrillator lead extractions.

Patients with devices, whether implanted at Emory or elsewhere, have access to Emory’s comprehensive follow-up care. Patients benefit from remote monitoring, quarterly atrial fibrillation support groups and 24-hour implantable cardiac device (ICD) and pacemaker monitoring services. Inpatient telemetry and coronary care units, as well as outpatient care and educational support of patients with pacemakers and ICDs, complete Emory’s comprehensive range of arrhythmia treatments and services.

Go Red for Your Heart

Go Red AtlantaHeart disease is the number one killer of women in the United States, but in many cases it’s preventable. That’s why Emory Healthcare would like to invite you to join us at one of our women’s heart health events in celebration and recognition of Heart Month in February, as well as Mother’s Day in May.

During these fun, educational events, participants will have an opportunity to meet Emory Women’s Heart Center physicians and staff and learn about how to prevent, detect and treat heart disease. You will also have the opportunity to purchase products and services from our vendors who will be on hand providing consultations, displaying jewelry, sharing healthy foods, etc.

To learn more, please call Emory HealthConnection℠ at 404-778-7777. The events are free! Parking will be available in hospitals’ main parking lots.

Go Red Event Details

When: Friday, February 6, 2015, 7:30 a.m. to 1:00 p.m.
Where: Emory Saint Joseph’s Hospital, Doctors Building Atrium

When: Friday, February 20, 2015, 7:30 a.m. to 1:00 p.m.
Where: Emory University Hospital, Hospital Auditorium

When: Friday, May 8, 2015, 7:30 a.m. to 1:00 p.m.
Where: Emory University Hospital Midtown, Medical Office Tower Atrium

Take action to prevent heart disease by attending a women’s heart health event and don’t forget to WEAR RED!

About the Emory Women’s Heart Center

Emory Women’s Heart Center is a unique program dedicated to screening, preventing and treating heart disease in women. The Center, led by nationally renowned cardiologist Gina Lundberg, MD provides comprehensive cardiac risk assessment and screenings for patients at risk for heart disease as well as full range of treatment options for women already diagnosed with heart disease care. Find out if you are at risk for heart disease by scheduling your comprehensive cardiac screening. Call 404-778-7777.

Congenital Heart Disease: Staying in Specialty Care Saves Lives

Congenital Heart DiseaseCongenital heart defects are the most common type of birth defect, affecting approximately 8 per 1000 births in the US. The severity of these defects ranges from mild defects that don’t require surgery to critical heart defects that require surgery within the first year of life for the baby to survive.

Advances in medical and surgical care have significantly improved survival for all CHDs, even the most complex, severe defects. As a result of these advances, the majority of children born with a heart defect now survive to adulthood, and the number of adults with congenital heart defects exceeds the number of children with CHD.

Despite these childhood successes, many adults with congenital heart disease face late complications, hospitalizations, need for medications, future surgeries, and may die at a younger age than their counterparts without a heart defect. The surgeries that permitted childhood survival often are a repair, rather than a “cure.” For this reason, those born with congenital heart defects require ongoing regular specialty care across the lifespan.

Unfortunately, some patients and their providers have the perception that the heart defect has been “cured.” The gaps in care resulting from this misperception can be harmful. Guidelines recommend that all adults with congenital heart defects stay in regular cardiology care, and those with moderate to complex (more severe defects) should receive care in an Adult Congenital Heart Center.

A recent publication showed that adults with congenital heart defects who receive care in an ACHD specialty center do better than those who receive non-specialty care, or receive no care at all. Those with more severe defects have the most to gain from specialty care. Unfortunately, less than a third of the patients who need this life saving specialty care actually receive care from an ACHD Center.

So what’s so special about an ACHD center?

  • Practice makes perfect. High-volume specialized centers improve patient outcomes by increasing physician experience, skill, and coordinated specialty teams.
  • Multidisciplinary teams work together to provide optimal care.
  • New and novel interventional and surgical techniques are developed at the centers.
  • Ongoing research gives patients access to cutting-edge treatments.
  • Resources are more readily available in a specialized center.

About the Congenital Heart Center of Georgia

The Congenital Heart Center of Georgia is an internationally recognized cardiology service that specializes in the care of adults with congenital heart defects (CHDs). Emory’s adult congenital heart program is the only adult congenital heart disease (ACHD) program in the state of Georgia, and is one of the largest programs in the country. Physicians at Emory’s Adult Congenital Heart Center have additional specialty training, beyond cardiology fellowship, in the diagnosis and management of adult with congenital heart defects.

Our Physicians

Appointments

To schedule an appointment at the Emory University Hospital campus, please call 404-778-5545. To schedule an appointment at our new Emory Saint Joseph’s Hospital campus, please call 404-778-6070.

About Dr. Book

Wendy Book, MDWendy Book, MD, is the director of the Emory Adult Congenital Heart Center. She has 15 years of experience in adult congenital heart disease, including clinical and research experience. She has a background in heart failure, transplantation and pulmonary hypertension, which complement skills of other Emory Adult Congenital Heart Center physicians. She is board certified in Internal Medicine, Cardiovascular disease, Advanced Heart Failure and Transplant Cardiology.

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Healthy Gift Ideas for Everyone on Your List!

Need some help checking everyone off your holiday shopping list? We’ve got a some great ideas to keep you and the people you love healthy this holiday season and in the New Year!

Massage – Who doesn’t love a good massage? Man or woman, we can all benefit from a decreased risk of heart disease by reducing our stress levels.

Gym bag – For the person in your life that is always at the gym, or for someone who needs new swag to motivate them to get to the gym.

Yoga – For the friend that could benefit from flexibility, surprise him or her with a yoga mat or a session at their local yoga studio.

Exercise tracker – From the FitBit to the Up Move, tech gadgets make working out more fun than ever. Increasing steps and decreasing calorie intake will lead to a leaner, healthier friend or family member.

Blender – Your mom or wife will love you for getting her a fancy new blender! The best part? She’ll be able to whip up some amazing smoothies for breakfast to help curb her appetite throughout the day.

Bike – Know someone who might enjoy biking to work or school? A bike is a great way to get the people you love moving.

Sneakers – Everyone could benefit from a new pair of running or hiking shoes. Plan a fun trek to the top of Stone Mountain or a jog around Piedmont Park.

Sports bra – You may not believe the difference a proper fitting sports bra will make! With the appropriate amount of support, your friend or sister could work out longer and harder.

Knife set – Guys like sharp objects, and getting a new knife set is as equally exciting as getting a new tool set, expect the knife set can help him create those delicious sweet potato chips you love to snack on!

Emory Women’s Heart Center Screening – Did you know that heart disease is the leading cause of death among women? Show the women in your life just how much you care about them by scheduling a screening at the Emory Women’s Heart Center. She’ll get two hours of undivided attention to help her understand her risk of heart disease.

To learn more about the Emory Women’s Heart Center
or to make an appointment, call 404-778-7777.

Happy holidays from Emory Healthcare!

Takeaways from Dr. Lundberg’s Heart-Healthy Holiday Eating Chat

heart health holiday eatingThanks to everyone who joined us Tuesday, December 9, for our live online chat on “Heart-Healthy Holiday Eating,” hosted by the Clinical Director of the Emory Women’s Heart Center, Gina Lundberg, MD.

With holiday parties in full swing, many of us are staying busy and eating on the go or overindulging in sweet party treats. Dr. Lundberg discussed heart-healthy tips and recipes, as well as answered your questions on how to make smart food and drink decisions.

See all of Dr. Lundberg’s answers by checking out the chat transcript! Here are just a few highlights from the chat:

Question: What are some entrée or side substitutions I can make without losing the “holiday” touch?

Gina Lundberg, MDDr. Lundberg: Turkey and ham are both lean meat, so entrees aren’t usually the problem The side dishes are usually where we run into trouble. Feel free to have your ham, turkey, and even lean pork and beef, but try to avoid the potato-heavy, cheesy side dishes.

 

Question: I crave sweets every day. What can I do to satisfy my cravings without reaching for the chocolate?

Gina Lundberg, MDDr. Lundberg: The more sugar you eat, the more you crave sugar. If you stick to a diet that is higher in protein, you’ll be more satisfied and won’t crave sugar as much. Eating healthier snacks more frequently (fruit, veggies, raw nuts) will stop you from being hungry and eating the wrong things.

 

BONUS: Dr. Lundberg’s Top 10 Tips to Stay Healthy During the Holidays

holiday-health-tips

If you missed out on this live chat, be sure to check out the full list of questions and answers on the chat transcript. If you have additional questions for Dr. Lundberg, feel free to leave a comment in our comments area below.

 

How To Get the Most Out of Your Doctor’s Visit

Doctor VisitsGoing to the doctor takes time, often comes at some expense and can raise your anxiety level – especially if you are worried that something bad could be discovered. Excellent communication between you and your doctor is essential to a meaningful visit.

Here are a few brief tips to help you get the most from your visit with an Emory Heart & Vascular Center provider:

  1. Think about your top concerns ahead of time. Jot down your top 3 questions/concerns on a piece of paper and bring them in. Show this to the doctor or nurse when they first come in to the room.
  2. Don’t be afraid to ask for something to be repeated if you didn’t understand it.
  3. Make sure you leave the office with a clear understanding of what we know already regarding your health concerns, what the next steps are and what the possible outcomes of any testing are.
  4. Make sure you understand how to take any new medicines and why you were prescribed these medicines.
  5. Consider bringing a relative or friend with you who can listen and ask questions on your behalf – they won’t be as anxious and can help you remember what is said during the appointment.

I am honored to be one of the doctors at Emory. It is our goal here to treat YOU, not just your symptoms or condition. If you have a concern that you want to discuss with us, we are here to help you. Just call 404-778-7777 to make an appointment with an Emory physician near you.

About Dr. Cassimatis

Dimitri Cassimatis, MDDimitri Cassimatis, MD, is Assistant Professor of Medicine at Emory University and Director of the Coronary Care Unit at Emory University Hospital Midtown. He divides his clinical time between Emory University Hospital Midtown and Grady Memorial Hospital. He is also co-director of the first year medical student cardiovascular pathophysiology module at Emory’s School of Medicine. Dr. Cassimatis received his MD from Harvard University and then spent 11 years in the United States Army before joining Emory in 2010.

Emory Offers State-of-the-Art Therapies for Heart Rhythm Disorders

heart rhythm therapyHeart rhythm disorders (arrhythmias) are common medical problems that affect millions of Americans each year. Treatments for arrhythmias vary from simple medications to specialized procedures depending on the needs of a particular patient. Fortunately, due to rapidly advancing technology, available therapies are quickly changing.

As one of the premier medical research centers in the Southeast, Emory offers some of the most cutting-edge treatments available for a wide variety of heart rhythm disorders. Highlighted below are just a few of these new advances:

Wireless pacemakers

The world’s smallest pacemakers are being implanted at Emory as part of an ongoing clinical trial. The Micra leadless pacemaker is an investigational device that is about one-tenth the size of a standard pacemaker. This device is approximately the length of a paperclip and round, like a capsule. This capsule contains all of the components of the pacemaker including the battery, and eliminates the need for the wire that is part of a standard pacemaker system.

One of the key benefits of the Micra pacemaker is that fact that it is implanted using a catheter through a vein in the front of the leg. The device is inserted directly into the heart. This process is generally quicker than a standard pacemaker procedure, and avoids the need for a surgical incision. Patients who have slow heart rates with weakness, lightheadedness, or fainting may be candidates for the Micra pacemaker clinical trial. Emory is the only center in Georgia that is participating in this trial.

Subcutaneous defibrillators

Defibrillators are devices that are designed to detect and treat life-threatening heart rhythm abnormalities. They are traditionally inserted under the skin in the patient’s shoulder, with a wire (or “lead”) that travels through a vein into the heart. While these devices have proven very effective, the presence of a defibrillator lead within the bloodstream may be associated with certain long-term complications. These may include infection or scarring of the blood vessel.

The subcutaneous defibrillator is a new type of device that is placed under the skin just like a standard defibrillator. However, this new device has a lead that travels just under the skin without having to be inserted through a blood vessel. This reduces the risks associated with infection.

Cryoablation for atrial fibrillation

Atrial fibrillation is the most common heart rhythm disorder, and can be treated in a variety of ways depending on the needs of the patient. One treatment option for this arrhythmia is catheter ablation. Traditionally, ablation for atrial fibrillation involves heating, or cauterizing, certain cells involved in the generation of atrial fibrillation. One new technique that has become available in the past several years is cryoablation. This therapy involves freezing cells with a super-cooled balloon that is positioned inside the heart with the use of a catheter. Cryoablation has the potential to be quicker than standard ablation, while having similar safety and effectiveness.

Ongoing clinical trials

Emory offers several clinical trials for patients who suffer from heart rhythm disorders. These trials represent opportunities to participate in the use of cutting-edge treatments that may not be available elsewhere. To learn more about ongoing heart rhythm clinical trials at Emory, please contact:

Emory University Hospital: Janice Parrott, 404-712-5592, jparrot@emory.edu
Emory University Hospital Midtown: Paige Smith, 404-686-7992, pfsmith@emory.edu
Emory St. Joesph’s Hospital: Cindy Barnes, 678-843-6093, cynthia.barnes@emory.edu

About Dr. Hoskins

Michael Hoskins, MDMichael Hoskins, MD, is an assistant professor of medicine and electrophysiologist who practices primarily at Emory University Hospital. Dr. Hoskins received his medical degree from the Medical College of Wisconsin in Milwaukee, after which he completed his residency in internal medicine at Emory. He was chief resident in Internal Medicine from 2005 to 2006. He then completed fellowships in cardiology and electrophysiology, also at Emory, and has been practicing here since 2010. He specializes in treating cardiac arrhythmias, focusing on ablation of arrhythmias and implantation and management of pacemakers and defibrillators.

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Atrial Fibrillation and New Anticoagulation Medications

AnticoagulantsAtrial Fibrillation is a very common heart rhythm disorder that may affect patients of all ages. Typically, this type of heart arrhythmia causes symptoms including palpitations, chest pain, dizziness or shortness of breath. However, it is important to note that this disorder can sometimes (especially in the elderly) be present without any symptoms whatsoever. While this arrhythmia is often associated with other heart conditions (valve problems, hypertension, coronary artery disease, congestive heart failure), in many patients, there is nothing else wrong with the heart. Patients with atrial fibrillation or atrial flutter and 1 or more risk factors for stroke such as simply being older than 65, having diabetes or hypertension, having a history of heart failure or prior mini-strokes are often prescribed anticoagulant drugs to prevent a stroke. For decades, physicians have prescribed Coumadin (warfarin) to reduce the risk. Importantly, aspirin is not nearly as effective as Coumadin in reducing the risk of stroke in patients with atrial fibrillation and is not considered an anticoagulant.

Patients taking Coumadin require blood tests every 4-8 weeks to monitor the proper dose to be sure the drug is effective and to reduce the risk of bleeding. Certain foods can reduce the effectiveness of the drug (such as leafy greens or spinach) and often medications can interact with Coumadin that potentially increase the risk of bleeding (especially certain antibiotics). Despite these drawbacks, Coumadin has effectively been utilized for decades to reduce the risk of stroke in patients with atrial fibrillation.

In the past 5 years, newer anticoagulants have been approved by the FDA for reducing the risk of stroke in patients with atrial fibrillation. These include Pradaxa, Xaelto and Eliquis. Drugs such as Clopidogrel (Plavix) are not used for this purpose and like aspirin are antiplatelet drugs used for other purposes. These newer anticoagulants have the advantage of not requiring blood tests to monitor their efficacy and they have fewer interactions with foods and other medications. Large clinical trials have been performed for each of the above newer anticoagulants and 3 drugs have been tests in head to head comparisons with Coumadin for efficacy and bleeding complications. The trials have demonstrated that all of the newer agents are at least as effective as Coumadin without a significant increase in bleeding risk. Despite the fact that all the newer agents do not have an antidote (such as vitamin K or plasma) in patients who are bleeding, this has not translated into a significant increase in bleeding risk in the large trials, and therefore, is why they have been approved by the FDA.

That being said, all anticoagulants carry a risk of bleeding and the decision to use Coumadin or any of the newer drugs is a decision requiring close consultation and discussion with your physician. It is important to promptly notify your physicians if you have had atrial fibrillation, are not taking an anticoagulant and you have any symptoms of a mini-stroke, even if the symptoms resolve on their own.

It is also important to note that all of the above also applies to patients with atrial flutter, another arrhythmia similar to atrial fibrillation. The above does not apply to patients with palpitations and tachycardia unless atrial fibrillation or atrial flutter has been confirmed with an EKG.

If you have symptoms that suggest you might have episodes of atrial fibrillation or you have already been diagnosed with an arrhythmia and wish to discuss the use of Coumadin or any of the newer agents, you can contact your existing cardiologist, or call HealthConnection at 404-778-7777 to make an appointment with an Emory cardiologist near you.

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